Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer

an Italian multicenter study

Massimiliano Bissolati, Matteo Desio, Fausto Rosa, Stefano Rausei, Daniele Marrelli, Gian Luca Baiocchi, Giovanni de Manzoni, Damiano Chiari, Giovanni Guarneri, Fabio Pacelli, Lorenzo de Franco, Sarah Molfino, Chiara Cipollari, Elena Orsenigo

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Resection margin (RM) involvement is associated with negative prognosis after gastrectomy. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is time-consuming and resource-consuming. The aim of this study was to assess risk factors associated with RM involvement to identify patients who would benefit from IFS analysis. Methods: We retrospectively analyzed patients who underwent gastrectomy with curative intent for gastric or esophagogastric junction (EGJ) cancer from 2000 to 2014 in six Italian hospitals. RM status was assessed by IFS analysis and/or definitive histopathology examination. A set of 21 potential risk factors were compared in a multivariate analysis between patients with positive RMs on IFS analysis or definitive histopathology examination and a control cohort of similar patients with negative RMs, with the samples stratified into three subgroups (T1, T2–T4 Lauren intestinal pattern, T2–T4 Lauren diffuse/mixed pattern). Results: One hundred forty-five patients had positive RMs. Survival was significantly worse in positive RM patients than in negative RM patients (89.5 months vs 28.9 months). Multivariate analysis showed that in T1 cancers a margin distance of less than 2 cm is a risk factor for RM involvement (odds ratio 15.7), in T2–T4 intestinal pattern cancers, serosa invasion (odds ratio 6.0), EGJ location (odds ratio 4.1), and a margin distance of less than 3 cm (odds ratio 4.0) are independent risk factors, and in T2–T4 diffuse/mixed pattern cancers, lymphatic infiltration (odds ratio 4.2), tumor diameter greater than 4 cm (odds ratio 3.5), EGJ location (odds ratio 2.8), and serosa invasion (odds ratio 2.2) are independent risk factors. Conclusions: Survival after gastrectomy is negatively affected by positive RMs. IFS analysis should be routinely used in patients with a high risk of positive RMs, especially in diffuse pattern cancers.

Original languageEnglish
Pages (from-to)1-13
Number of pages13
JournalGastric Cancer
DOIs
Publication statusAccepted/In press - Jan 5 2016

Fingerprint

Esophagogastric Junction
Statistical Factor Analysis
Multicenter Studies
Stomach
Odds Ratio
Frozen Sections
Neoplasms
Gastrectomy
Serous Membrane
Multivariate Analysis
Intestinal Neoplasms
Survival
Margins of Excision

Keywords

  • Esophagogastric junction
  • Gastrectomy
  • Gastric cancer
  • Intraoperative frozen section
  • Resection margins
  • Risk factors

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer : an Italian multicenter study. / Bissolati, Massimiliano; Desio, Matteo; Rosa, Fausto; Rausei, Stefano; Marrelli, Daniele; Baiocchi, Gian Luca; de Manzoni, Giovanni; Chiari, Damiano; Guarneri, Giovanni; Pacelli, Fabio; de Franco, Lorenzo; Molfino, Sarah; Cipollari, Chiara; Orsenigo, Elena.

In: Gastric Cancer, 05.01.2016, p. 1-13.

Research output: Contribution to journalArticle

Bissolati, M, Desio, M, Rosa, F, Rausei, S, Marrelli, D, Baiocchi, GL, de Manzoni, G, Chiari, D, Guarneri, G, Pacelli, F, de Franco, L, Molfino, S, Cipollari, C & Orsenigo, E 2016, 'Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study', Gastric Cancer, pp. 1-13. https://doi.org/10.1007/s10120-015-0589-6
Bissolati, Massimiliano ; Desio, Matteo ; Rosa, Fausto ; Rausei, Stefano ; Marrelli, Daniele ; Baiocchi, Gian Luca ; de Manzoni, Giovanni ; Chiari, Damiano ; Guarneri, Giovanni ; Pacelli, Fabio ; de Franco, Lorenzo ; Molfino, Sarah ; Cipollari, Chiara ; Orsenigo, Elena. / Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer : an Italian multicenter study. In: Gastric Cancer. 2016 ; pp. 1-13.
@article{73cfbdbd8efd432b880d772b39e03e3e,
title = "Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study",
abstract = "Background: Resection margin (RM) involvement is associated with negative prognosis after gastrectomy. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is time-consuming and resource-consuming. The aim of this study was to assess risk factors associated with RM involvement to identify patients who would benefit from IFS analysis. Methods: We retrospectively analyzed patients who underwent gastrectomy with curative intent for gastric or esophagogastric junction (EGJ) cancer from 2000 to 2014 in six Italian hospitals. RM status was assessed by IFS analysis and/or definitive histopathology examination. A set of 21 potential risk factors were compared in a multivariate analysis between patients with positive RMs on IFS analysis or definitive histopathology examination and a control cohort of similar patients with negative RMs, with the samples stratified into three subgroups (T1, T2–T4 Lauren intestinal pattern, T2–T4 Lauren diffuse/mixed pattern). Results: One hundred forty-five patients had positive RMs. Survival was significantly worse in positive RM patients than in negative RM patients (89.5 months vs 28.9 months). Multivariate analysis showed that in T1 cancers a margin distance of less than 2 cm is a risk factor for RM involvement (odds ratio 15.7), in T2–T4 intestinal pattern cancers, serosa invasion (odds ratio 6.0), EGJ location (odds ratio 4.1), and a margin distance of less than 3 cm (odds ratio 4.0) are independent risk factors, and in T2–T4 diffuse/mixed pattern cancers, lymphatic infiltration (odds ratio 4.2), tumor diameter greater than 4 cm (odds ratio 3.5), EGJ location (odds ratio 2.8), and serosa invasion (odds ratio 2.2) are independent risk factors. Conclusions: Survival after gastrectomy is negatively affected by positive RMs. IFS analysis should be routinely used in patients with a high risk of positive RMs, especially in diffuse pattern cancers.",
keywords = "Esophagogastric junction, Gastrectomy, Gastric cancer, Intraoperative frozen section, Resection margins, Risk factors",
author = "Massimiliano Bissolati and Matteo Desio and Fausto Rosa and Stefano Rausei and Daniele Marrelli and Baiocchi, {Gian Luca} and {de Manzoni}, Giovanni and Damiano Chiari and Giovanni Guarneri and Fabio Pacelli and {de Franco}, Lorenzo and Sarah Molfino and Chiara Cipollari and Elena Orsenigo",
year = "2016",
month = "1",
day = "5",
doi = "10.1007/s10120-015-0589-6",
language = "English",
pages = "1--13",
journal = "Gastric Cancer",
issn = "1436-3291",
publisher = "Springer Japan",

}

TY - JOUR

T1 - Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer

T2 - an Italian multicenter study

AU - Bissolati, Massimiliano

AU - Desio, Matteo

AU - Rosa, Fausto

AU - Rausei, Stefano

AU - Marrelli, Daniele

AU - Baiocchi, Gian Luca

AU - de Manzoni, Giovanni

AU - Chiari, Damiano

AU - Guarneri, Giovanni

AU - Pacelli, Fabio

AU - de Franco, Lorenzo

AU - Molfino, Sarah

AU - Cipollari, Chiara

AU - Orsenigo, Elena

PY - 2016/1/5

Y1 - 2016/1/5

N2 - Background: Resection margin (RM) involvement is associated with negative prognosis after gastrectomy. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is time-consuming and resource-consuming. The aim of this study was to assess risk factors associated with RM involvement to identify patients who would benefit from IFS analysis. Methods: We retrospectively analyzed patients who underwent gastrectomy with curative intent for gastric or esophagogastric junction (EGJ) cancer from 2000 to 2014 in six Italian hospitals. RM status was assessed by IFS analysis and/or definitive histopathology examination. A set of 21 potential risk factors were compared in a multivariate analysis between patients with positive RMs on IFS analysis or definitive histopathology examination and a control cohort of similar patients with negative RMs, with the samples stratified into three subgroups (T1, T2–T4 Lauren intestinal pattern, T2–T4 Lauren diffuse/mixed pattern). Results: One hundred forty-five patients had positive RMs. Survival was significantly worse in positive RM patients than in negative RM patients (89.5 months vs 28.9 months). Multivariate analysis showed that in T1 cancers a margin distance of less than 2 cm is a risk factor for RM involvement (odds ratio 15.7), in T2–T4 intestinal pattern cancers, serosa invasion (odds ratio 6.0), EGJ location (odds ratio 4.1), and a margin distance of less than 3 cm (odds ratio 4.0) are independent risk factors, and in T2–T4 diffuse/mixed pattern cancers, lymphatic infiltration (odds ratio 4.2), tumor diameter greater than 4 cm (odds ratio 3.5), EGJ location (odds ratio 2.8), and serosa invasion (odds ratio 2.2) are independent risk factors. Conclusions: Survival after gastrectomy is negatively affected by positive RMs. IFS analysis should be routinely used in patients with a high risk of positive RMs, especially in diffuse pattern cancers.

AB - Background: Resection margin (RM) involvement is associated with negative prognosis after gastrectomy. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is time-consuming and resource-consuming. The aim of this study was to assess risk factors associated with RM involvement to identify patients who would benefit from IFS analysis. Methods: We retrospectively analyzed patients who underwent gastrectomy with curative intent for gastric or esophagogastric junction (EGJ) cancer from 2000 to 2014 in six Italian hospitals. RM status was assessed by IFS analysis and/or definitive histopathology examination. A set of 21 potential risk factors were compared in a multivariate analysis between patients with positive RMs on IFS analysis or definitive histopathology examination and a control cohort of similar patients with negative RMs, with the samples stratified into three subgroups (T1, T2–T4 Lauren intestinal pattern, T2–T4 Lauren diffuse/mixed pattern). Results: One hundred forty-five patients had positive RMs. Survival was significantly worse in positive RM patients than in negative RM patients (89.5 months vs 28.9 months). Multivariate analysis showed that in T1 cancers a margin distance of less than 2 cm is a risk factor for RM involvement (odds ratio 15.7), in T2–T4 intestinal pattern cancers, serosa invasion (odds ratio 6.0), EGJ location (odds ratio 4.1), and a margin distance of less than 3 cm (odds ratio 4.0) are independent risk factors, and in T2–T4 diffuse/mixed pattern cancers, lymphatic infiltration (odds ratio 4.2), tumor diameter greater than 4 cm (odds ratio 3.5), EGJ location (odds ratio 2.8), and serosa invasion (odds ratio 2.2) are independent risk factors. Conclusions: Survival after gastrectomy is negatively affected by positive RMs. IFS analysis should be routinely used in patients with a high risk of positive RMs, especially in diffuse pattern cancers.

KW - Esophagogastric junction

KW - Gastrectomy

KW - Gastric cancer

KW - Intraoperative frozen section

KW - Resection margins

KW - Risk factors

UR - http://www.scopus.com/inward/record.url?scp=84953323119&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84953323119&partnerID=8YFLogxK

U2 - 10.1007/s10120-015-0589-6

DO - 10.1007/s10120-015-0589-6

M3 - Article

SP - 1

EP - 13

JO - Gastric Cancer

JF - Gastric Cancer

SN - 1436-3291

ER -